In January, because of Paul's diagnosis, his Medicare kicked in. I thought that would offer some relief for the cost of his medicine. Boy, was I wrong! Paul is on 9 medicines, most are directly related to the symptoms of his AD. One is for a different, minor medical issues. And, he takes Morphine for pain associated with a crumbling neck fusion he had nearly 20 years ago. Not only has he never abused his Morphine, but because I manage his medicines, I make sure he takes half the dosage than is prescribed.
Morphine is a controlled substance. It requires a hard copy script from the doctor. I drove into Bend today to our local Walgreen's where my employer, Deschutes County Behavior Health, has a contract and they reminded me I need a hard copy. There was a 40 minute drive down the drain and is an example of issue one for caregivers. We get tired too! We forget too! I made the trip useful and ran some other errands, planning to return home to Paul. Our oldest was home with him while I was gone.
As I work closely with his physician (because of my job), I stopped into the medical clinic to get the hard copy and decided to use the local pharmacy even though the prescription might cost more. The doctor's medical assistant was busy (she is a hard-working gal) so I decided to run some more errands in town and called to let my son know why it was taking so long. No one answered the phone. I assumed Paul was sleeping and Zach was in his room.
After 40 minutes, when I returned to the clinic, they gave me the hard copy so I brought it right next door to the local pharmacy. I gave them our insurance card and asked them to make copies of the Medicare card so that both insurances could be billed. I sat an waited for them to fill the prescription. After about 10 minutes, a young woman approached to tell me the Oregon Health Plan (medicare administrator in Oregon) was having problems with their electronic health system. The pharmacy could not access approval or coverage because OHP's system was "down."
So, I indicated I would pay for the co-pay and suggested they just bill my county insurance as normal. I waited another 15 minutes.
The same lovely lady approached me to tell me my insurance (NWPS) would not approve the prescribed medication because they wanted Paul to sign a pain contract. I explained Paul could not sign - nor understand - the contract because he has Alzheimer's - but they indicated they could not fill the prescription without the company's authorization. So, I called NWPS. The nice lady on the phone told me is was Deschutes County's policy to require a pain contract for anyone on a pain medicine. I explained why the pain contract was meaningless in this case. I further explained that as they can see when we fill his Morphine prescriptions, they can tell he does not abuse his medication. Indeed, they can tell we fill them nearly one month later than we are able. She told me they still needed the doctor to confirm it was "okay to give him the pain medication." I asked her what it means to her that the doctor was the one the signed the prescription in the first place. She restated she was just following policies.
I am pleased I remained calm - especially as I was sitting in a small, local pharmacy. I asked her to think like a human being. I told her the last time this particular medication was delayed, Paul ended up on a two-physician hold in the psychiatric unit of the local hospital. Indeed, any medication change can affect someone with dementia in horrible ways. They cannot handle change - in environment, behaviors, habits, or pain. I told her this decision would end up with him in the ER and asked if the insurance company would rather pay for that bill. She spoke with her supervisor and they agreed to a one-time refill. Thank you kind human being at NWPS.
So I spoke to the lovely lady at the pharmacy and she re-submitted the prescription. I waited another 15 minutes. Then she appoached my again. I thought I would start to cry. The doctor had prescribed enough pills to cover 37 days rather than 30. The insurance company refused to pay for the additional 7 day supply AND, the Oregon Health Plan site was still down. If I wanted the medication I would have to pay for the co-pay and for the additional 7 days by myself. Fine. FINE. Six hours since I left my husband at home and I just wanted to get back to him. FINE! I payed the bill and got home, thinking I got what I needed for him and everything would be okay.
Then, when I got home, Paul was sitting on the front porch. I could tell he was distressed. What happened? He found the keys to our second car and drove out the front gate of our property. He thought to help in my absence. He thought it was garbage day (it is NOT garbage day). He wanted to bring to garbage out to the gate using the Rodeo. Only, he did not remember to put the car in park when he stopped at the gate. He actually put it in reverse instead. It back over him, knocked him to the ground, and then ran into a tree. He was more concerned about the car than his person. Ever feel like you just cannot take any more distress? I am just at my end today...
Does 6 hours messing with the insurance and medications matter? It sure does. Especially when ANYTHING can happen in that six hours. I could have lost him today. I praise God I did not, and yet I am so mad that it took 6 hours to get his medication today. I could have lost him.
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